急性心肌梗死后不同时间直接冠状动脉介入治疗分析

目的观察急性ST段抬高型心肌梗死（STEMI）患者发病后不同时间行直接冠状动脉介入治疗（PCI）的临床疗效。方法 53例首次确诊为STEMI的患者均行直接PCI治疗,其中发病至就诊时间≤6 h 32例（A组）,发病至就诊时间6～12 h 21例（B组）,观察两组疗效、梗死相关动脉（IRA）开通时间、住院期间主要心脏不良事件（MACE）发生率等。结果 A组术后无复流发生率明显低于B组（P〈0.05）、ST段回落（STR）率、左心室射血分数（LVEF）均明显高于B组（P〈0.05）;肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）及左心室舒张末期内径（LVEDD）均明显低于B组（P均〈0.01）;两组住院期间MACE发生率差异无统计学意义（P〉0.05）;两组IRA开通时间差异无统计学意义（P〉0.05）。结论 STEMI患者就诊延迟现象普遍存在,尽早行直接PCI可减少无复流率、改善心肌再灌注、减小心肌梗死范围。     

易化PCI治疗ST段抬高型急性心肌梗死临床疗效及安全性的应用研究

目的:探讨易化PCI(F-PCI)治疗STEMI的临床疗效和安全性.方法:入选F-PCI组(B组)患者立即于院前嚼服阿司匹林、氯毗格雷各300 mg,减量应用尿激酶(UK)100万U行静脉溶栓治疗后送心脏介入中心行PCI:人选直接PCI组(A组)患者不应用尿激酶行静脉溶栓治疗即送心脏介入中心行急诊PCI.结果:B组患者PCI术后达TIMI血流3级、IRA开通率、ST段回落率和出院前LVEF显著高于A组,两组患者IRA残余狭窄率差异无显著性,住院期间均罕见MACE.结论:F-PCI治疗ST段抬高型急性心肌梗死(STEMI)具有显著的临床疗效和较高的安全性.     

替罗非班对急性ST段抬高型心肌梗死直接经皮冠状动脉介入术后心肌灌注和临床预后的影响

目的观察替罗非班对ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉介入术（PCI）后心肌灌注和临床预后的影响。方法选择75例符合直接PCI的急性STEMI患者,随机分为替罗非班实验组（38例）和对照组（37例）,实验组在PCI基础上加替罗非班,对照组直接行PCI,观察两组术后心肌缺血再灌注损伤,住院期间主要心血管事件（MACE）及临床预后。结果治疗组在PCI术前后冠脉TIMI以及TMP分级、心电图ST段回落、7d后左心室射血分数（LVEF）、主要心血管事件（MACE）发生率等方面显著优于对照组,术后肌钙蛋白I（cTnI）峰值、住院天数、出血并发症、住院期间主要心血管事件（MACE）两组之间无差异。结论对于急性STEMI行PCI前应用替罗非班可更有效地改善冠脉血流及临床预后,方法安全。     

替罗非班对急性ST段抬高型心肌梗死直接经皮冠状动脉介入术后心肌灌注和临床预后的影响

目的观察替罗非班对ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉介入术（PCI）后心肌灌注和临床预后的影响。方法选择75例符合直接PCI的急性STEMI患者,随机分为替罗非班实验组（38例）和对照组（37例）,实验组在PCI基础上加替罗非班、对照组直接PCI,观察两组术后心肌缺血再灌注损伤,住院期间主要心血管事件（MACE）及临床预后。结果治疗组在PCI术前后冠脉TIMI以及TMP分级、心电图ST段回落、7d后左心室射血分数（LVEF）、主要心血管事件MACE发生率等方面显著优于对照组,术后肌钙蛋白I（cTnI）峰值、住院天数、出血并发症、住院期间主要心血管事件（MACE）两组之间无差异。结论对于急性STEMI行PCI前应用替罗非班可更有效的改善冠脉血流及临床预后,方法安全。     

次全量尿激酶溶栓联合急诊PCI治疗急性ST段抬高型心肌梗死的临床研究

【摘要】目的探讨次全量尿激酶溶栓联合急诊冠状动脉介入治疗（PCI）治疗急性ST段抬高型心肌梗死（STEMI）的住院期间临床疗效和安全性。方法68例初发STEMI患者分为次全量尿激酶溶栓联合急诊PCI（易化PCI）组36例和直接PCI组32例,比较两组患者门．球时间、PCI手术时间、恶性再灌注心律失常发生率、PCI前后梗死相关血管（IRA）开通率、住院期间左室射血分数（LVEF）、住院期间出血事件及主要心脏不良事件（MACE）。结果两组患者自发病至就诊时间比较差异无统计学意义[（5．05±1．35）hV8（5．04±1．26）h,P〉0．05];易化PCI治疗组PCI术前IRA开通率、PCI术后IRA开通率和住院期间LVEF明显高于直接PCI组[41．7％VS18．8％,P〈0．05;97．2％v881．3％,P〈0．05;（57．00±6．73）％V8（51．34±5．28）％,P〈0．05];易化PCI组PCI手术时间、恶性再灌注心律失常发生率低于直接PCI治疗组[（1．08±0．25）hVS（1．53±0．38）h,P〈0．05;13．9％VS34．4％,P〈0．05];两组患者MACE、主要出血事件比较差异无统计学意义（P〉0．05）;易化PCI组门．球时间高于直接PCI组,差异有统计学意义[（92．69±19．02）minVS（78．00±11．18）min,P〈0．05]。结论次全量尿激酶溶栓联合急诊PCI治疗STEMI能提高PCI术前和术后IRA再通率,改善心室功能,降低恶性再灌注心律失常发生率,减少PCI手术时间,且不增加MACE和出血风险,有应用价值。     

血栓抽吸导管在ACS急诊PCI中的临床应用研究

目的探讨血栓抽吸导管治疗在ACS常规急诊PCI中的临床疗效。方法选择2010年1月-2011年5月我院住院行急诊经皮冠状动脉介入（PCI）治疗的93例急性ST段抬高型心肌梗死和高危、极高危非ST段抬高急性冠脉综合症（ACS）患者,随机分为联用ThrombusterⅡ血栓抽吸导管治疗为A组（51例）,同期未应用血栓抽吸导管治疗为B组（42例）。比较两组患者术后心肌梗死溶栓（TIMI）血流、校正TIMI帧数（CTFC）、术后心肌呈色分级（BMG）、术后ST段抬高回落幅度及左心室射血分数（LVEF）、住院期间主要心血管不良事件（MACE）有无差异。结果 A组TIMI血流3级、CTFC、BMG、术后ST段抬高回落幅度及LVEF均优于B组,差异均有统计学意义（P〈0.05）。两组患者院内MACE发生率比较,差异无统计学意义（P〉0.05）。结论在ACS常规急诊PCI中联用ThrombusterⅡ血栓抽吸导管治疗可显著改善患者TIMI血流、心肌组织水平灌注及术后心功能,但住院期间MACE的发生率无差异。     

冠脉替罗非班联合血栓抽取在ST段抬高AMI急诊PCI治疗中的临床观察

目的：观察血栓抽吸联合替罗非班在ST段抬高心肌梗死（ STEMI ）急诊直接经皮冠状动脉介入治疗（ PCI ）中的临床疗效。方法纳入40例急诊STEMI患者,根据患者治疗方案的不同将其分为两组,每组各20例。 A组进行血栓抽吸＋替罗非班冠脉内给药,B组进行血栓抽吸。观察术后两组患者ST段抬高回落百分比、血浆肌钙蛋白I（cTnI）峰值,左室舒张末内径（LVDd）,左室射血分数（LVEF）,B－型钠尿肽（BNP）,大出血、主要心脏不良事件（MACE）发生率。结果 A组ST段抬高回落百分比、cTnI值、LVDd、LVEF、脑钠肽（ BNP）水平等均显著优于B组,差异均有显著性（ P＜0．05）。两组患者大出血以及主要心脏不良事件发生率等差异均无显著性（P＞0．05）。结论血栓抽吸＋替罗非班冠脉给药应用在STEMI急诊PCI,能够有效降低无复流的发生率,改善患者心肌灌注,改善预后,值得推广。     

急性心肌梗死经皮腔内冠脉介入治疗后心电图ST段回落不良与临床预后的关系研究

目的:研究急性心肌梗死(acute myocardial infarction,AMI)经皮腔内冠脉介入治疗(percutaneous coronary intervention,PCI)后心电图ST段回落(ST segment resolution,STR,STR)不良与患者临床近、远期预后关系。方法:选取发病12 h内于我院导管室行急诊PCI治疗的110例急性ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)患者的临床资料,根据术后1 h常规12导联心电图STR程度分为对照组(STR≥50%,n=59)和STR不良组(STR<50%,n=51),比较两组患者PCI术后住院期间不良心脏事件发生率以及术后1、6及12个月时左心房内径、左心室舒张末径、左心脏室射血分数、左心室短轴缩短率、E峰/A峰等心脏超声各项指标之间的差异。结果:STR不良组住院期间MACE发生率和住院时间明显高于对照组(P<0.05)。STR不良组术后1、6、12个月心脏功能明显低于对照组,心室重构明显高于对照组(P<0.05)。结论:ST段抬高型AMI患者经PCI术后,STR程度与临床近、远期预后密切相关,ST充分回落可作为预测病人近期、远期临床预后良好指标。     

冠状动脉内注射替罗非班对大量血栓负荷的急性ST段抬高型心肌梗死的疗效和安全性研究

目的：在急诊经皮冠状动脉介入治疗（PCI）过程中,观察对有大量血栓负荷的急性ST段抬高型心肌梗死（STEMI）患者直接冠状动脉内注射替罗非班的疗效和安全性．方法：104例有大量血栓负荷的急性ST段抬高型心肌梗死患者,随机分为冠脉内注入替罗非班组56例和对照组48例,比较两组间的冠状动脉血流、ST段回落率、住院期间和30d时主要不良心血管事件（MACE）及出血等并发症．结果：冠脉内注入替罗非班组的梗死相关血管TIMI3级血流比例增多（89．3％vs85．4％,P〈0．05）、框格计数法计算的梗死相关血管血流量增加[（1．68±0．23）mL／s vs（1．42±0．31）mL/s,P〈0．05]、心电图ST段回落幅度变大[（64．3±7．8）％w（48．6±6．5）％,P〈0．05）]、住院期间和30d时的MACE事件发生率降低（10．7％vs18．8％,P〈0．05）,与对照组比较差异有统计学意义,而出血并发症和血小板减少症发生率两组间差异无统计学意义．结论：急诊PCI时,对血栓负荷重的急性STEMI冠状动脉内注射替罗非班治疗方法简单、安全和行之有效．     

脑钠素水平在评价急性心肌梗死介入治疗中的价值

目的判定脑钠素水平在评价急性非sT段抬高型心肌梗死和急性ST段抬高型心肌梗死患者行急诊冠状动脉介入治疗后心功能与临床结果的关系。方法研究入选急诊PCI的NSTEMI患者20例、STEMI患者40例，于PCI后采集血液检测血浆BNP水平，根据BNP中位数将患者分为两组，高BNP组（BNP≥160ng／L）和低BNP组（BNP〈160ng／L）。比较两组患者特征、左室收缩功能、STEMI心电图ST段回落和住院期间主要并发症。结果高BNP组较低BNP组左室收缩功能降低（左室射血分数，P〈0．01）、左室舒张末期容积减少（P〈0．01）、长期大量吸烟和糖尿病患者多（60％：40％，P〈0．05；65％：45％，P〈0．05）、STEMIST段回落减少（P〈0．01）、住院期间急性左心衰发生增多（25％：5％，P〈0．01）。结论急性心肌梗死急诊PCI患者，血浆BNP的升高水平可作为评价PCI术后近期心功能及心肌再灌注的敏感指标。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.